Commentary

Abstract

Hepatocellular carcinoma (HCC) has reached endemic proportions in this region due to the very high prevalence of viral hepatitis. Considerable radiological resources are used in the early detection of these tumours. Some studies had suggested that MR imaging with liver specific agents were better at detecting and characterizing early disease. Baeka et al report their experience where they have compared gadoxetic acid enhanced MR with multiphase CT. Gadoxetic acid is a liver specific agent and is taken up and excreted by the hepatocytes in the bile. It uses gadolinium as its paramagnetic component. In their study they demonstrate that for lesions over 1 cm in size the diagnostic performance was the same. Gadoxetic acid enhanced MR was however better for smaller lesions. As most of the tumours we encounter are larger than 1cm this study may suggest that multiphase CT is adequate however an alternate view is that screening programs using gadoxetic acid enhanced MR may improve the detection of early disease and improve overall outcomes. Unfortunately none of the liver specific agents are currently available in Pakistan.